CHA Blog

The California Antipsychotic Drug Collaborative recently investigated 24 nursing homes and found 147 violations of state rules regarding the use of antipsychotics on residents. Their investigations confirm the disturbing and rampant misuse of antipsychotics in California nursing homes and call attention to a situation that deserves immediate remedial action.

Medicare has designated January as National Glaucoma Awareness Month as a way to increase people’s awareness of glaucoma and Medicare’s covered glaucoma screening benefit. More than 2.2 million Americans age 40 and older have open angle glaucoma, the most common form of glaucoma, and at least half of them don’t even know they have it.  Through early detection and treatment, blindness can be prevented.

As mentioned, Medicare provides coverage of an annual glaucoma screening for beneficiaries in at least one of the following high-risk groups:

• Individuals with diabetes mellitus
• Individuals with a family history of glaucoma
• African-Americans age 50 and older
• Hispanic-Americans age 65 and older.

Medicare’s coverage of glaucoma screening includes a dilated eye examination with an intraocular pressure (IOP) measurement and a direct ophthalmoscopy examination or a slit-lamp biomicroscopic examination.

What you can do to help spread the word to beneficiaries…

If you are a Medicare advocate or healthcare professional who provides care to seniors and others with Medicare, you can help protect the vision of your high-risk patients by educating them about their risk factors and reminding them of the importance of getting an annual glaucoma screening exam covered by Medicare.

For More Information:

• The CMS Glaucoma Screening Brochure
• The CMS Guide to Medicare Preventive Services (see Chapter 7)
• The MLN Preventive Services Educational Products Webpage
• The National Eye Institute

Thank you for partnering with Medicare to promote increased awareness of glaucoma and Medicare’s covered glaucoma screening benefit.

CVS Caremark Corporation will pay $5 million to settle Federal Trade Commission charges that it misrepresented the prices of certain Medicare Part D prescription drugs – including drugs used to treat breast cancer symptoms and epilepsy – at CVS and Walgreens pharmacies. The allegedly deceptive claims caused many seniors and disabled consumers to pay significantly more for their drugs than they expected and pushed them into the “donut hole” – known as the coverage gap where none of their drug costs are reimbursed – sooner than they anticipated or planned. The settlement will bar deceptive claims related to Medicare Part D drug prices and require CVS Caremark to pay $5 million to reimburse affected Medicare Part D consumers for the price discrepancy.

According to the FTC complaint, CVS Caremark offers Medicare Part D prescription drug plans through subsidiaries like RxAmerica, which CVS Caremark acquired in October 2008. Many consumers choose their Medicare Part D drug plans by looking up plan benefits and drug prices on RxAmerica’s website, by going to the Centers for Medicare & Medicaid Services website and using the web-based tool Plan Finder, or by visiting other third-party websites where such information is posted.

The FTC charged that from 2007 through at least November 2008, RxAmerica posted on its website and supplied for posting to Plan Finder and third-party websites incorrect prices for Medicare Part D prescription drugs at two pharmacy chains, CVS and Walgreens. In some instances, the actual prices for these drugs were as much as 10 times more than the posted prices. As a consequence of the deceptive price claims, many elderly and disabled consumers chose RxAmerica plans and paid significantly more than they expected for their drugs at CVS and Walgreens.

The proposed settlement order bars CVS Caremark from misrepresenting the price or cost of Medicare Part D prescription drugs or other prices or costs associated with Medicare Part D prescription drug plans. It requires that CVS Caremark pay $5 million in consumer refunds. The FTC will be mailing checks to eligible consumers who were harmed by these misrepresentations after the order becomes final. The settlement also contains standard record-keeping provisions to allow the FTC to monitor compliance with its order.

After a thorough and comprehensive review of other consumer protection and competition issues in this matter, the FTC issued a letter closing the investigation. The FTC will publish a description of the consent agreement package in the Federal Register soon. The agreement will be subject to public comment for 30 days, that 30-day period began January 12 and continues through February 13, 2012, after which the Commission will decide whether to make the proposed consent order final. You are welcome to submit written comments electronically or in paper form by following the instructions in the “Invitation To Comment” part of the “Supplementary Information” section. Comments can be submitted on an electronic form, or in paper form if mailed or delivered to: Federal Trade Commission, Office of the Secretary, Room H-113 (Annex D), 600 Pennsylvania Avenue, N.W., Washington, DC 20580. The FTC is requesting that any comment filed in paper form near the end of the public comment period be sent by courier or overnight service, if possible, because U.S. postal mail in the Washington area and at the Commission is subject to delay due to heightened security precautions.

This article is edited from the 1/12/12 FTC press release. For more information, visit the FTC website.

When Congress debated cutting payments to Medicare Advantage plan sponsors, what did the sponsors threaten?  To get out of the Medicare market.  Yet can they really afford not to be in the Medicare market, especially given that 3 of the top Fortune 500 companies in 2011 were WellCare Health Plans, Humana, and Centene, all of which are health insurers with a high proportion of Medicare Advantage enrollees? WellCare’s share price has nearly doubled while Humana and Centene are up about 50%.

Here’s an article about profits these sponsors are earning.

If you have time, also watch the video with Dr. Donald Berwick on “How to heal health care” at the end of the article.